反加疗法在促性腺激素释放激素激动剂治疗内异症中减缓骨量流失的荟萃分析  

A meta-analysis of preventing bone mineral loss in patients with endometriosis treated bygonadotrophin-releasing hormone analogues with add-back therapy1

作　　者：牛子儒[1] 岳晓静[1] 孔群钰[2] 王元芬[1] 姚元庆[1] 

机构地区：[1]解放军总医院妇产科,北京100853 [2]复旦大学卫生统计学教研室

出　　处：《中华妇产科杂志》2013年第5期338-343,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的评价反加疗法在促性腺激素释放激素激动剂（GnRH—a）治疗内异症中减缓骨量流失的作用及有效性。方法检索Medline数据库、Embase数据库、Cochrane图书馆数据库、中国知网（CNKI）、中国生物医学文献数据库（CBM）、万方数据库，收集国内外应用GnRH—a及反加疗法治疗内异症开展的随机对照临床试验（RCT），对纳入的研究进行质量评价，提取数据，采用Stata11．0软件对用药前后骨密度、生殖激素水平和疼痛视觉模拟评分法（VAS）评分进行荟萃分析。结果排除不符合纳入标准、随访期或失访人数不明确、重复发表、文献质量过低的研究后，最终共纳入13项RCT研究，调查对象累积785例[反加组（GnRH—a联合雌激素）：377例，单药组（单独使用GnRH—a）408例]。荟萃分析显示：（1）与单药组相比，反加组可减少骨量流失[标准化均数差（SMD）=0．223，95％CI：0．005～0．443，P=0．047]；（2）反加组与单药组对血清雌激素水平的影响不显著（SMD=-0．053，95％CI：-0．479～0．373，P=0．807）；（3）两组治疗后VAS评分比较，差异无统计学意义（SMD=-0．157，95％CI：-0．474～0．160，P=0．332）。结论应用GnRh—a联合雌激素的反加疗法对内异症患者疗效较好且可减缓骨量流失，优于单独应用GnRH—a。Objective To evaluate the role and efficacy of preventing bone mineral loss in patients with endometriosis treated by gonadotrophin-releasing hormone analogues （ GnRH-a ） combined with add- back therapy. Methods Prospective, randomized controlled studies of the use of GnRHa with add-back therapy in treatment of endometriosis were enrolled in this study from Medline, Embase, Cochrane library, China National Knowledge Internet （ CNKI ） , Chinese Biological Medicine Disk （ CBM ） and Data Base of Wanfang. After quality assessment and data extraction, meta-analysis were conducted in the change of BMD, reproductive hormone （ E2 ） and visual pain score （ VAS ） by Stata 11.0 software. Results A total of 785 patients from 13 randomized controlled trail （RCT） studies enrolled in this study after exclude no following up, poor quality and repeat published studies. 377 patients were in group of GnRH-a with add-back treatment and 408 patients were in group of GnRna alone. The findinds were showed in meta-analysis ： （ 1 ） there was a significant difference in percentage change of bone mineral density （BMD） between two groups, the add- back therapy was more effective in prevention of bone loss which was （SMD = O. 223, 95% CI：O. 003 to 0. 443, P = 0. 047 ）. （ 2 ） There was no significant difference in the level of reproductive hormone between two groups （SMD - -0. 053,95% CI： -0. 479 to 0. 373 ,P =0. 807）. （3） There was also no significant difference in the visual pain score between the two groups （SMD = -0. 157, 95% CI： -0. 474 to 0. 160, P =0. 332）. Conclusions GnRH-a with add-back therapy have been shown to be more effective in preventing loss of BMD than GnRH-a treatment alone. However, the long term effect of preventing BMD should be studied.

关 键 词：促性腺素释放激素 雌激素类 子宫内膜异位症 骨密度 Meta分析 

分 类 号：R711.71[医药卫生—妇产科学]